The Role of Betadine Irrigation in Breast Augmentation

Sir: We read with great interest the article entitled “The Role of Betadine Irrigation in Breast Augmentation” by Dr. Wiener.1 We are in complete agreement with the author, and we would like to draw the readers’ attention to our own work published in the Journal a few years ago.2 We were also frustrated with the U.S. Food and Drug Administration’s labeling requirement, which affected saline-filled implants as well as silicone gel implants, similar to the ones commonly used in Europe. We therefore conducted an experimental in vitro study to assess the effect of povidone iodine on the physical properties of the implant shells. Solutions of povidone iodine with concentrations ranging from 0.01% to 10% (Betadine Solution neat) were used. Our study showed that there is no effect on the mechanical properties of the implant shells from the use of povidone iodine for irrigation of the pocket or the implant itself. Although our study was performed on shells from gel-filled implants, these shells are the same as those used for saline-filled implants, and our conclusions can also be applied to those. The issue of fibroblast toxicity by povidone iodine raised by Dr. Wiener has been the object of several studies.3–6 We would like to submit that this effect could actually be beneficial in the battle against capsular contracture. Prantl et al.7,8 showed that fibroblasts were among the main cellular populations identified histologically in breast implant capsules, and this toxicity on fibroblasts could explain why povidone iodine has been found to be one of the most effective irrigants in decreasing capsular contracture.1 Of course, further studies are warranted to identify the quantitative effect of povidone iodine on this cellular population, but we believe that this issue should be taken into consideration when discussing capsular contracture prevention. George J. Zambacos, M.D. Artion Plastic Surgery Center Athens, Greece Department of Plastic Surgery Derriford Hospital Plymouth, United Kingdom Apostolos D. Mandrekas, M.D. Artion Plastic Surgery Center Athens, Greece Robert J. Morris, M.D. Department of Plastic Surgery Derriford Hospital Plymouth, United Kingdom